Comparing Quality of Dying and Death Perceived by Family Members and Nurses for Patients Dying in US and Dutch ICUs
Comparing Quality of Dying and Death Perceived by Family Members and Nurses for Patients Dying in US and Dutch ICUs
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DOI：
10.1016/j.chest.2016.09.003
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发表时间：
2017-02-01
期刊：
影响因子：
9.6
通讯作者：
Spronk, Peter E.
中科院分区：
文献类型：
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作者：
Gerritsen, Rik T.;Koopmans, Matty;Spronk, Peter E.
背景：死亡与死亡质量（QODD）问卷是一种自我报告的测量方法，允许家属和临床医生评估患者的死亡与死亡质量。我们评估了由美国和荷兰的家庭和护士完成的QODD测量的生命末期（EOL）经历，以探索这些经历的异同，并确定改善EOL护理的机会。方法：对ICU死亡患者家属及护理人员进行问卷调查。在荷兰，数据收集自三所教学医院，数据收集自美国参与随机试验的12个地点。QODD由25个项目组成，并已在美国进行了验证。结果：分析了446例患者的数据（346例在美国，100例在荷兰）。荷兰患者比美国患者年龄大（72 + 10.2岁vs 65 + 16.0岁；P < 0.0025）。两国家庭评估的总体QODD得分相同：荷兰=中位数，9；四分位数间距（IQR）为8-10，美国=中位数，8；差,5 - 10。美国家庭成员对“与亲人共度的时光”和“独处的时光”这两项的评价高于荷兰家庭。护士评估的QODD评分各不相同：荷兰的单项QODD总结得分明显更高（荷兰：中位数，9；IQR， 8-10比美国：中位数，7；IQR, 5-8; P < 0.0025），而美国的QODD总分更高（荷兰：中位数，6.9；IQR, 5.5-7.6比美国：中位数，7.1；IQR, 5.88.4; P = 0.014），尽管不符合我们的统计显著性标准。在22项护士评估项目中，有10项在荷兰和美国之间存在显著差异，其中美国有8项得分较高，荷兰有2项得分较高。结论：美国和荷兰家庭成员对QODD的评价相似，但护士对QODD的评价不同。这些差异可能是由于两国之间的组织或文化差异或受访者的期望。
BACKGROUND: The Quality of Dying and Death (QODD) questionnaire is used as a selfreported measure to allow families and clinicians to assess patients' quality of dying and death. We evaluated end-of-life (EOL) experiences as measured by the QODD completed by families and nurses in the United States and the Netherlands to explore similarities and differences in these experiences and identify opportunities for improving EOL care.METHODS: Questionnaire data were gathered from family members of patients dying in the ICU and nurses caring for these patients. In The Netherlands, data were gathered in three teaching hospitals, and data was gathered from 12 sites participating in a randomized trial in the United States. The QODD consists of 25 items and has been validated in the United States.RESULTS: Data from 446 patients were analyzed (346 in the United States and 100 in the Netherlands). Dutch patients were older than those in the United States (72 + 10.2 years vs 65 + 16.0 years; P < .0025). The family-assessed overall QODD score was the same in both countries: the Netherlands = median, 9; interquartile range (IQR), 8-10 and the United States = median, 8; IQR, 5-10. US family members rated the quality of two items higher than did the Netherlands families: "time spent with loved ones" and "time spent alone." Nurseassessed QODD ratings varied: the single-item QODD summary score was significantly higher in the Netherlands (the Netherlands: median, 9; IQR, 8-10 vs the United States: median, 7; IQR, 5-8; P < .0025), whereas the QODD total score was higher in the United States (the Netherlands: median, 6.9; IQR, 5.5-7.6 vs the United States: median, 7.1; IQR, 5.88.4; P = .014), although it did not meet our criteria for statistical significance. Of the 22 nurse-assessed items, 10 were significantly different between the Netherlands and the United States, with eight having higher scores in the United States and 2 having higher scores in the Netherlands.CONCLUSIONS: The QODD was rated similarly by family members in the United States and the Netherlands but varied when assessed by nurses. These differences may be due to organizational or cultural differences between the two countries or to expectations of respondents.